Tuesday, October 31, 2017

Could Your Fitbit Prevent a Stroke?

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October 31, 2017

Last week, at the Connected Health Conference in Boston, researchers from Fitbit presented some data that didn't get as much attention as they should have. Part of that was due, perhaps, to how the study was presented—not in a high-profile, main-stage session, but rather on a sheet of cardboard during the meeting's "poster session." That's where you typically find hordes of post-doctoral researchers desperately searching for an audience for their work, as conference-goers mill around between panel discussions. Still, this is where you'll often find some of the best stuff at medical meetings.

In this case, Fitbit, the San Francisco wearable pioneer, presented data on an algorithm it had developed to detect a certain dangerous heart arrhythmia, called atrial fibrillation, using a technology already built into its wristband trackers: photoplethysmography, or PPG.

Fitness trackers have long used PPG devices to monitor pulse rates. The tiny sensors, which consist of infrared light-emitting diodes (LEDs) coupled with a sensitive light detector, measure infinitesimal gradations in light in human tissue, due to changing blood volume in the microvasculature as blood circulates through the body—a process that follows in rhythm with the beating of the heart. (For those interested, there's a great description of how the technology works here.) And while PPG itself is actually some 80 years old , Fitbit's team has developed an algorithm that can, if its latest findings hold true, accurately detect persistent atrial fibrillation (AFib) in a person wearing one of its wristband trackers—and, importantly, not over-detect it (that is to say: not flag it in a normal beating heart).

The Fitbit team tested its algorithm on heart-tracking data from four cohorts: two groups of test subjects as they sat quietly in place (which included 16 patients with persistent AFib matched with 21 heart-healthy subjects), plus two groups of sleeping volunteers (the first with persistent AFib, as above, and the second with normal sinus rhythms). The researchers then sliced up all that heart-tracking data into overlapping one-minute and five-minute stretches in order to see how well they could peer into any given testing "window" with their algorithm and detect the arrhythmia.

The data presented last week, though not peer-reviewed, suggests they can do that remarkably well—with the algorithm, in the five-minute testing windows, detecting AFib with a 99.3% rate of sensitivity and a 0.8% rate of "false positives." In other words, it nearly always found an arrhythmia when it was there, and almost never found it when it wasn't.

What makes these findings so intriguing—and potentially important—is that atrial fibrillation is a major risk factor for stroke. In AFib—which affects as many as 3% of the population, with most cases occurring in those over 65—the electrophysiology of the heart is out of whack, and its two upper chambers (the atria) fibrillate , or quiver, instead of contracting fully. That sometimes allows small amounts of blood to pool in the chambers rather than being pushed through. And when blood remains in one place over time it tends to clot. Such clots, in turn, can break off and get stuck in the narrow blood vessels of the brain, causing a stroke. Those with AFib have a four- to five-times-higher risk of stroke than those with normal heart rhythms.

One key limitation of the recent Fitbit study, says Dr. Vincent Thijs, an expert on stroke at the University of Melbourne’s Florey Institute of Neuroscience and Mental Health, is that it demonstrates only that the tracker and algorithm can detect persistent or permanent atrial fibrillation, rather than paroxysmal AFib (or short, sudden spasms). The latter are often undiagnosed for years and are thought to lead to many strokes as well. But Thijs believes that wearable devices that can reliably detect paroxysmal AFib aren't far away. "This space is moving quickly," he says.

Dr. Venkatesh Raman , an interventional cardiologist at MedStar Georgetown University Hospital, agrees. Raman, who is co-Principal Investigator for the ongoing Fitbit-sponsored research on AFib (but who was not an author of the study presented at Connected Health), says he thinks this will one day change the practice of cardiology. "So it is kind of funny how we practice outpatient care," he says. "I might see a patient once or twice a year—If they’ve been in the hospital, I might see them a few more times—but the vast majority of their life occurs outside our office setting. But if we have these devices, we have the ability, perhaps, to collect [the data that we need.]" And rather than use a "one-size-fits-all paradigm for who and what needs treatment," he says, physicians can treat their patients based on real-world, 24/7 data—which means they can treat them on a smarter, more individualized basis.

Indeed, what makes AFib such a good test case for the digital health revolution is that, once caught, it can often be treated cheaply and effectively with oral anticoagulants. So discovering someone who has an undiagnosed arrhythmia isn't a useless exercise: Rather, it might just save a life.

More news below.

Clifton Leaf, Editor in Chief, FORTUNE
@CliftonLeaf
clifton.leaf@fortune.com
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DIGITAL HEALTH

Novartis snatches up cancer "radiotherapy" firm Advanced Accelerator Applications. Swiss drug giant Novartis has struck a deal to acquire France's Advanced Accelerator Applications (AAA) for $3.9 billion, or a nearly 50% premium on the company's closing share price before knowledge of the deal became public. This is yet another addition to Novartis' quest to rule the advanced and next-generation cancer therapy space following its milestone FDA approval for a cancer gene therapy treatment. AAA's medical tech uses trace levels of radioactive compounds to both map out and fight cancer. ( CNBC)

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INDICATIONS

Mylan No. 2 targeted in massive generic drug price collusion probe. Rajiv Malik, president and executive director at EpiPen maker Mylan (essentially the company's number two exec), has been named in a wide-ranging civil suit alleging drug price collusion by numerous prominent generic drug makers. Malik is one of the highest-ranking biopharma officials to date named in the probe by dozens of state attorneys general for alleged price fixing; Mylan is strongly denying the claims. Its stock fell 8% in Tuesday trading. (Bloomberg)

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THE BIG PICTURE

WellCare stock hits record high after demolishing Wall Street expectations. Shares of Florida-based WellCare Health Plans hit an all-time high Tuesday, rising 10% after the managed care health insurer absolutely smashed analyst projections in its latest earnings report. WellCare's net income rose more than $100 million in the third quarter of 2017 compared to the same time period last year thanks to stellar growth in its Medicare business and much lower-than-expected medical costs for its Medicaid plan holders relative to their premiums.

Aetna CEO mum on CVS deal. Aetna CEO Mark Bertolini didn't have a lot to say about his company's potential blockbuster deal with CVS on an earnings call Tuesday. The firm did report better than expected profits in the third quarter, and could potentially return to a bigger presence in the individual insurance market once uncertainty around Obamacare stabilizes. (Reuters)

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Drones Can Save Lives—If the Government Lets Themby Joe Rinzel

Produced by Sy Mukherjee
@the_sy_guy
sayak.mukherjee@fortune.com

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On Sex Trafficking and Free Speech

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October 31, 2017

How do we protect vulnerable people in a technological age?

This is the fundamental question behind "I Am Jane Doe,” a documentary film by Mary Mazzio, that explores the trafficking and sexual enslavement of children and teens, specifically enabled by online advertisements.

I attended a St. Louis-area screening of the film last night. It is a disturbing look at how girls – typically runaways, or otherwise temporarily separated from friends or caretakers — can be lost to rings of predators who find a seemingly never-ending supply of customers online.

But "I Am Jane Doe" also excels as a legal thriller, a nail-biter which follows the quest of several desperate parents of formerly trafficked girls who enlist the aid of local, under-prepared attorneys to help them find justice. Their target is Backpage.com, a website that was once part of Village Voice Media, which serves the majority of these problematic ads, making tens of millions in the process.

That the first brave mother to file suit against Backpage in 2010 was from Ferguson, Mo., makes a difficult story even more poignant.

But the true villain in the drama is Section 230 of the 1996 Communications Decency Act or CDA, a tiny legislative carve-out which protects websites that post third-party content from being subject to civil or criminal liability. As a result, the heartbreaking legal efforts of families to shut down Backpage.com over a period of six years were doomed from the beginning.

While the individual stories cannot possibly fail to move you, the legislative solution the film supports is more complicated.

Mazzio is crisscrossing the country screening the film and participating in panel discussions about recent bipartisan legislation, the Stop Enabling Sex Traffickers Act or SESTA (S. 1693) which aims to amend the CDA specifically to allow websites that "facilitate" sex trafficking to now be held liable. (You can see the film anytime on Netflix, among other places.)

The film showcases the work of high profile Senators: Arizona's John McCain, Missouri's Claire McCaskill, and Ohio's Rob Portman, chiefly among them. And as the lawsuits mount, the legal arguments get more interesting as well.

Spoiler alert: If you were a fan of jurist Richard Posner before this film, you probably won't be afterward.

But the other villains in the piece are Google, Facebook, Twitter, and other technology companies who rely on third-party content.

SESTA, which would allow state attorneys general to prosecute websites under state laws, could open up a potential floodgate of wide-ranging lawsuits. "We recognize that attempts to amend Section 230 target sex traffickers are well intended. However, the likely result will be to create a trial lawyer bonanza of overly-broad civil lawsuits," says Gary Shapiro of the Consumer Technology Association.

"[M]ost tech companies have been circumspect about their opposition to the bill, choosing to voice their concerns by proxy through trade groups like the Internet Association, which includes Google, Facebook, Microsoft, Amazon, and Twitter among its members," says The Verge in this useful explainer.

But lately, worried about being on the wrong side of an emotional issue, big tech is signaling some openness to change.

In recent Senate testimony, Abigail Slater, the Internet Association's general counsel said in addition to criminal sanctions against Backpage, "We also support targeted amendments to the Communications Decency Act that would allow victims of sex trafficking crimes to seek justice against perpetrators."

Disney, Fox, HP, IBM, and Oracle have recently signed on in favor of the bill.

There's a lot at stake, particularly now as Facebook, Google, and Twitter head back to Capitol Hill to explore how Russian trolls may have influenced the U.S. election. "The abuse of our platform by sophisticated foreign actors to attempt state-sponsored manipulation of elections is a new challenge for us — and one that we are determined to meet," says Twitter's acting general counsel in written testimony.

But propaganda, like sexual coercion and abuse, is nothing new.

Important cultural issues are surfaced in “I Am Jane Doe,” but largely ignored. The girls, once rescued, faced bullying, blaming and shaming from their peers. They feel isolated and alone. The men who paid to have sex with them — often suburban men with jobs, families, and reputations to protect — are rarely punished. And the parents are still struggling to find ways to help their traumatized daughters heal. That this is how we treat women should come as no surprise in the #MeToo era.

While we all need to better understand SESTA, one thing remains clear. If we want to protect vulnerable people online or anywhere else, it would help if we also faced these bigger, real-world issues head-on. That’s something that all the Decency Acts in the world won’t be able to do for us.

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On Point

So far, the racist costume of the season involves Colin Kaepernick
I know it's still early, but there seems to be a clear trend in the making. First, a campus police officer at the University of Nevada put on a wig and fake nose, painted on a beard, donned a homemade 49ers jersey and scrawled a sign that said,"will stand for food." After photos were shared, the director of police services on campus was forced to issue an apology.  Then, at Dickinson College in Carlisle, Pa., a student was photographed in blackface and a Kap wig, looking stupid, with someone else holding a gun to his head. I won't link to the vile photo, but the obligatory apology from Dickinson's dean of student life is below.
Dickenson
Twitter is attempting to crack down on revenge porn
Revenge porn is a nasty form of retaliation, perpetrated by jilted or otherwise disturbed former associates when they post sexually explicit photos or videos of others without their consent. Twitter has done a poor job of preventing this in the past. While their previous rules prevented users from posting "intimate photos or videos that were taken or distributed without the subject's consent," the new rules go into greater detail about what constitutes "compromising imagery." Hope it helps.
Fortune
Top editor Michelle Lee is winning at Allure
Lee earned kudos a couple of months back for banning the term "anti-aging" at the woman's publication, to stop "reinforcing the message that aging is something we need to battle." She's also been a champion for diverse faces and points of view, tackling real issues head-on — like mastectomies and transgender activism. And Muslim model Halima Aden appeared on the cover of the July "American Beauty" issue — the first time a woman wearing hijab was featured on the cover of a major American magazine.
Ad Week
Native American activist Dennis Banks has died
Banks, who helped found the American Indian Movement in 1968, died from complications after heart surgery. He was 80. Banks may have been best known for leading the group's 1973 takeover of Wounded Knee on the Pine Ridge Reservation in South Dakota, in a 71-day protest against both the U.S. and tribal governments."Dennis Banks is somebody who had an indelible impact on history, not just in our native community but throughout our country," said Anton Treuer, a professor of the Ojibwe language at Bemidji State University. Banks died surrounded by friends and loved ones. Click through to his Facebook page for stories and tributes. His bio is below.
Associated Press
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The Woke Leader

Writer Ta-Nehisi Coates takes on John Kelly and Civil War revisionism
White House Chief of Staff John Kelly continues to be a polarizing figure. After he lauded Confederate general Robert E. Lee as a hero, and said that the Civil War was caused by a "lack of compromise," writer Ta-Nehisi Coates woke up early and took Twitter to civics class. "Regarding John Kelly's creationist theorizing on Lee and the Civil War, its worth pointing out a few things," he began in a detailed thread on history, compromise, and war. "This stuff is knowable," he said. "But you do have to actually read what the people who started the War actually said." And, this: "You do have to get these guys were the worst of America.
Twitter
The mathematical genius of John Coltrane
Coltrane was a magical figure to many — part transcendent jazzman, part spiritual seeker. Those two elements came together in a sketch experts called "the Coltrane circle," a version of the musical "circle of fifths" — a representation of the twelve tones of the chromatic scale — but amplified with a Coltrane twist. Some see elements of Islam in the sketch, a musical mathematics that's connected to the divine. But in addition to his mystical journey, "Coltrane was also very much aware of Einstein's work and liked to talk about it frequently," says musician and writer Josh Jones. "Musican David Amram remembers the Giant Steps genius telling him he "was trying to do something like that in music."
Open Culture
Halloween: A cautionary tale
Last year, a man dressed as Cookie Monster in New York's Times Square district attempted to break up a fight between a man dressed as a pilot and a man dressed as a stereotype of a Native American. The pilot, who was portraying a Tuskegee Airman, set upon the other man, declaring the costume "racist." He pulled a knife when Cookie Monster attempted to intervene. Cookie Monster was treated and released. I hate Halloween.
Gothamist
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Quote

Our position is thoroughly identified with the institution of slavery — the greatest material interest of the world. Its labor supplies the product which constitutes by far the largest and most important portions of commerce of the Earth. These products are peculiar to the climate verging on the tropical regions, and by an imperious law of nature, none but the black race can bear exposure to the tropical sun. These products have become necessities of the world, and a blow at slavery is a blow at commerce and civilization.
—Mississippi's Declaration Secession
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